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NPI Code Detail

MEDICARE: ERICH STEVENS RN

MEDICARE: ERICH STEVENS RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0809XAdult Psychiatric/Mental Health Registered Nurse531308CA

General Provider Information

NPI Number : 1639254253
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICH STEVENS RN
Provider Business Mailing Address
First Line : 1526 KEARSARGE RD
Second Line :
City : LA JOLLA
State : CA
Zip : 92037-3824
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3132 JEFFERSON ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-4421
Country : US
Telephone Number : 619-683-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 03/10/2011

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